Journal of Emergency Medicine最新文献

{"title":"Infectious Disease and Supportive Care Outcomes in Adult Oncology Patients","authors":"Sidharth Iyer BS ,&nbsp;Jason J Bischof MD","doi":"10.1016/j.jemermed.2025.04.036","DOIUrl":"10.1016/j.jemermed.2025.04.036","url":null,"abstract":"<div><h3>Background</h3><div>Patients with cancer on immunosuppressive drugs face an increased risk for serious bacterial infections and commonly present to the emergency department (ED) with bacterial bloodstream infections (BSIs), making prompt administration of antibiotics critical. However, for ED oncology patients presenting with fever in the absence of neutropenia, there is limited data to guide their management. To address this gap in care, the Esbenshade model was developed to stratify BSI risk in febrile non-neutropenic pediatric oncology patients. In this study, we aimed to evaluate whether this model retains its predictive accuracy in an adult population.</div></div><div><h3>Methods</h3><div>This retrospective single site chart review analyzed adult oncology patients presenting to an urban, academic ED in the Midwest affiliated with a Comprehensive Cancer Center. Inclusion criteria encompassed patients diagnosed with malignancy and presenting with non-neutropenic fever. Patients with a history of remote cancer or without fever within 24 hours of presentation were excluded. Retrospective chart review data was collected using the Esbenshade (EsVan2b) model variables and were analyzed using descriptive statistics, and sensitivity and specificity calculations to evaluate the model's predictive accuracy.</div></div><div><h3>Results</h3><div>284 patients met the inclusion criteria. The median patient age was 63 years, with 58% being male and 81% identifying as white. Blood cultures were positive in 66 out of the 284 febrile episodes (BSI rate = 23%). The Esbenshade model in an adult population demonstrated a sensitivity of 0% and a specificity of 98%, and an AUC of 0.680.</div></div><div><h3>Conclusion</h3><div>The retrospective data demonstrate that the EsVan2b model performed poorly in predicting BSI risk in adult cancer patients presenting with non-neutropenic fever. This suggests that the model may not be suitable for use in the adult population and highlights the need for further research to develop or adapt predictive tools for this demographic.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Page 142"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Window Falls: Factors Related to Clinical Outcomes Within a State Trauma Registry","authors":"Laura Waagmeester MD ,&nbsp;David Sheridan MD, MCR ,&nbsp;Amber Lin MS ,&nbsp;Ben Hoffman MD, CPST-I, FAAP ,&nbsp;Christian Graulty MD ,&nbsp;Kelsey Ige MD ,&nbsp;Matt Hansen MD, MCR","doi":"10.1016/j.jemermed.2025.08.004","DOIUrl":"10.1016/j.jemermed.2025.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Accidental injuries are a common cause of morbidity and mortality in pediatrics. Among these, unintentional window falls are a common but preventable reason for emergency department presentations.</div></div><div><h3>Objective</h3><div>The objective of this study was to describe the demographics and characteristics of pediatric window falls and to identify geographic clusters of injury occurrences in Portland, Oregon.</div></div><div><h3>Methods</h3><div>Children treated at trauma centers in Portland, Oregon for unintentional window falls between 2005 and 2016 were identified retrospectively and data were collected exclusively from chart review. We then used specific fall addresses to create maps to visually identify clusters within the Portland metropolitan area.</div></div><div><h3>Results</h3><div>A total of 399 patients were included; median age was 3 years, with a male predominance (66%). Mortality was 1%. Most of the children fell from 2nd story windows (84%). Most children received at least one computed tomography scan, and the majority (72%) were admitted to the hospital. Landing on a hard surface (odds ratio [OR] 6.33, 95% confidence interval [CI] 3.22–12.46) and witnessed loss of consciousness (OR 2.11, 95% CI 1.04–4.25) were associated with increased odds of severe injury. Mapping visually demonstrated clusters in many neighborhoods that did not overlap with areas of highest population density.</div></div><div><h3>Conclusion</h3><div>Pediatric window falls in Oregon follow demographic trends previously identified by studies of window falls in other major metropolitan areas. Although the risk of death was low, many patients required workup and hospitalization. Using visuospatial mapping, we were able to identify geographic clusters of falls in the Portland area, where future preventative strategies could target these higher-risk areas.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 224-234"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Age-Adjusted D-Dimer vs Traditional D-Dimer to Rule Out Acute Aortic Syndromes","authors":"Jacob Nelson MD ,&nbsp;Divyani Patel MD ,&nbsp;Sylvia Kashat MD ,&nbsp;Gorune Geloian ,&nbsp;Karen Childers MS ,&nbsp;David A. Berger MD ,&nbsp;Brett Todd MD","doi":"10.1016/j.jemermed.2025.08.001","DOIUrl":"10.1016/j.jemermed.2025.08.001","url":null,"abstract":"<div><h3>Background</h3><div>Acute aortic syndromes (AS), including aortic dissection, ulceration, and intramural hematoma, are rare and life-threatening diagnoses. Early diagnosis is critical as mortality increases by 1–2% per hour after symptom onset. D-dimer (DD) &lt; 500 ng/dL, with or without utilization of Aortic Dissection Detection Risk Score (ADD-RS), is a proposed method to rule-out AS in low-risk patients but is not specific. Age-adjusted D-dimer (AADD) has been validated for pulmonary embolism, but has not been studied extensively in AS.</div></div><div><h3>Objective</h3><div>In this study, we investigate the utility of AADD to DD when used to rule-out AS, with and without ADD-RS.</div></div><div><h3>Methods</h3><div>This is a retrospective study of patients presenting the emergency department (ED) from 2012 to 2021 who received a DD and underwent computed tomography angiography (CTA) for Dissection, Coronary Study, or Triple Rule-Out. Sensitivity and specificity for AS was calculated for both DD &lt; 500 ng/dL and AADD. Patients were excluded if they were pregnant, had prior thoracic aortic dissection or repair, presented altered, or younger than 18 years-old.</div></div><div><h3>Results</h3><div>In total, 5818 unique cases met inclusion criteria. In the DD &lt; 500 ng/dL group sensitivity was 0.979 (0.939–1.000) with a specificity of 0.727 (0.716–0.739). In the AADD group, sensitivity was 0.938 (0.869–1.000, <em>p</em> = 0.16) with a specificity of 0.781 (0.770–0.792, <em>p</em> &lt; 0.05). S</div></div><div><h3>Conclusions</h3><div>AADD appears to have comparable sensitivity, although with a diminished confidence interval, to DD when ruling out AS. Utilization of ADD-RS may help determine which patients are appropriate for screening. Future steps would include a prospective trial on patients presenting to the ED.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"78 ","pages":"Pages 241-247"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing and Conquering the Lipliner Artifact","authors":"Lori Stolz MD,&nbsp;Rob Ferre MD","doi":"10.1016/j.jemermed.2025.04.034","DOIUrl":"10.1016/j.jemermed.2025.04.034","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 157-158"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Management of Malignant Bowel Obstruction in Patients with Advanced Gynecological Cancers","authors":"Vikas Garg ,&nbsp;Nazlin Jivraj ,&nbsp;Bojan Macanovic ,&nbsp;Pamela Soberanis Pina ,&nbsp;Brooke Grant ,&nbsp;Crystal Wang ,&nbsp;Arundhati Shukla ,&nbsp;Azieb Tesfu ,&nbsp;Oyinlade Odujoko ,&nbsp;Ainhoa Madariaga ,&nbsp;Yeh Chen Lee ,&nbsp;Lisa Wang ,&nbsp;Ana Veneziani ,&nbsp;Valerie Bowering ,&nbsp;Robert C Grant ,&nbsp;Neesha C. Dhani ,&nbsp;Amit M. Oza ,&nbsp;Stephanie Lheureux","doi":"10.1016/j.jemermed.2025.04.040","DOIUrl":"10.1016/j.jemermed.2025.04.040","url":null,"abstract":"<div><h3>Background</h3><div>Malignant bowel obstruction (MBO) is a debilitating complication in advanced gynecological cancers, often leading to frequent emergency visits, prolonged hospitalization and poor survival outcomes.</div></div><div><h3>Methods</h3><div>A prospective study was conducted to assess implementation of a proactive MBO model of care (MOC) using a clinical risk-based triage system which includes standardized bowel function assessment tools, a bowel management regime, and education tools for patients and nurses. Management followed a defined algorithm, supported by an interdisciplinary team (IDT) comprising of oncologists, specialized oncology nurses (RN), surgeons, gastroenterologists, radiologists, palliative care specialists, and dietitians. Patients “at risk” of MBO received RN proactive phone calls to manage symptoms for up to 4 weeks. Patients with MBO, IDT informed treatment decisions, including inpatient interventions or ambulatory management, with continued RN proactive phone call management for 8 weeks. The objective was to optimize interdisciplinary management of MBO.</div></div><div><h3>Results</h3><div>We enrolled 92 patients, with 49% (n=45) presenting with MBO and 51% (n=47) classified as \"at risk\". Proactive outpatient management by RN led to symptom resolution in 93% of \"at-risk\" patients, with 7% progressing. Throughout the study, 62% (n=57) of patients experienced MBO, of which 93% (n=53) required inpatient management. All patients were discussed in IDT rounds. Surgical intervention was performed in 11% (n=6) of patients, and 77% (n=44) received chemotherapy. MBO resolution occurred in 42% (n=24) of patients within 60 days. 11% (n=6) experienced recurrent MBO episodes, and 58% (n=33) had persistent symptoms. The median hospitalization durations were 7 days (range, 0–30) and 12.5 days (range, 0–57) within the first 30 and 60 days after MBO diagnosis respectively. The ratio of days alive and out of the hospital within 60 days was 0.3 (range, 0–19).</div></div><div><h3>Conclusions</h3><div>This study demonstrates the feasibility of a proactive MBO MOC in an ambulatory setting, with most patients effectively managed as an outpatient with interdisciplinary support, resulting in reduced hospitalization.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 144-145"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Academy of Emergency Medicine","authors":"","doi":"10.1016/S0736-4679(25)00323-3","DOIUrl":"10.1016/S0736-4679(25)00323-3","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 163-164"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Host Protein Bio-Array Distinguishing Bacterial and Non-Bacterial Sources Provides Similar Diagnostics in Immunosuppressed Patients Presenting to the ED with Sepsis","authors":"D Robinson ,&nbsp;M Sheraton ,&nbsp;N Sepulveda ,&nbsp;J Boyle ,&nbsp;A Kane ,&nbsp;J Furbacher ,&nbsp;M Vu ,&nbsp;D Ticas ,&nbsp;B Karfunkle ,&nbsp;C Bakunas ,&nbsp;C Gardiner","doi":"10.1016/j.jemermed.2025.04.041","DOIUrl":"10.1016/j.jemermed.2025.04.041","url":null,"abstract":"<div><h3>Background</h3><div>Immunosuppressed (ISD) patients presenting to emergency departments (EDs) with sepsis concerns of unknown etiology require a broad work-up. A rapid immunoassay (MeMedBV©, (BV)) which measures TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10), C-reactive protein (CRP), and a proprietary ‘BV score’ are used to distinguish sepsis source (bacterial versus non-bacterial) but is unclear whether it is useful in ISD patients.</div></div><div><h3>Methods</h3><div>A case-controlled series comparing the diagnostic response of MeMedBV© on ISD subjects presenting with sepsis physiology. A definitive diagnosis of bacterial or non-bacterial infection was adjudicated through blood cultures, laboratory, and radiography. The BV scores and individual protein levels were tabulated for all ISD and immunocompetent (ICT) subjects. Comparison analysis using the non-parametric Kruskal-Wallis test assessed diagnostic accuracy between the ISD and ICT groups. The null hypothesis was that the BV and host protein scores are similar in the ISD compared to the ICT group in patients presenting with sepsis.</div></div><div><h3>Results</h3><div>For patients with bacterial etiology (n=13), the BV score comparison between ISD and ICT resulted in an H-statistic of 0.95 with a p-value of 0.33, TRAIL: H-statistic; 3.17, p-value 0.07, CRP: H-statistic; 1.84, p-value 0.17, and IP-10: H-statistic; 3.23, p-value of 0.07. In the non-bacterial group (n=6), the BV score comparison resulted in an H-statistic; 0.03, p-value of 0.87, TRAIL: H-statistic; 0.01, p-value 0.94, CRP: H-statistic; 0.24, p-value 0.62, and IP-10: H-statistic; 0.11, p-value 0.74. Thus, no significant differences of BV scores or host proteins were reported between ISD and ICT groups.</div></div><div><h3>Conclusion</h3><div>This host 3-protein bio-array and BV score performed similarly in both immunosuppressed and immunocompetent groups. A rapid diagnostic test measuring host protein response may therefore be useful in distinguishing bacterial and non-bacterial sources of infection despite ISD status. Further studies with larger sample sizes and various causes of ISD are recommended to refine diagnostic performance in clinical settings.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Page 145"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Study of Biplane Imaging in Ultrasound-Guided Peripheral Vascular Access Performed by Novice Operators","authors":"Ethan Murphy BS","doi":"10.1016/j.jemermed.2025.04.033","DOIUrl":"10.1016/j.jemermed.2025.04.033","url":null,"abstract":"","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Page 156"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Sepsis Program in the Oncology Emergency Department","authors":"John Stroh MD,&nbsp;Patricia Brock MD,&nbsp;Olivia Lennon MS,&nbsp;Rowena Montoya RN,&nbsp;Serah Homena RN,&nbsp;Rachel Gansit RN,&nbsp;Alyssa Hughes RN","doi":"10.1016/j.jemermed.2025.04.042","DOIUrl":"10.1016/j.jemermed.2025.04.042","url":null,"abstract":"<div><div>The Emergency Department at the University of Texas MD Anderson Cancer Center has implemented a multidisciplinary approach to address suspected sepsis patients that arrive to the emergency department. The sepsis program includes: an electronic health record best practice advisory, interdisciplinary text alert and overhead page. The program also includes an interdisciplinary team which reviews all sepsis cases that do not meet the sepsis bundle.</div><div>The sepsis program is comprised of two main components: recognition and sepsis review.<blockquote><div><u><em>Recognition</em></u></div><div><em>If the patient meets two mSIRS criteria the sepsis BPA is triggered. Upon trigger of the BPA or based on clinical judgement the triage RN initiates the sepsis parameter orders and activate the sepsis response by both overhead page and interdisciplinary text message</em>.</div><div><u><em>Review</em></u></div><div><em>Bi-monthly Sepsis Pulse Check meetings enable case discussion with the interdisciplinary team. Before each meeting, nurses review all sepsis fallouts from the preceding week and share findings with nursing leadership, assigned physician reviewers and pharmacist. Nurses present cases during meetings, fostering interdisciplinary collaboration for improvements. This allows the team to work together to identify gaps in care and follow up on any changes that are needed</em>.</div></blockquote></div><div>Our institution has maintained the lowest sepsis mortality index compared to comprehensive cancer centers in the United States. The department has improved door to antibiotic administration within one hour compliance from fiscal year 2023 to 2024 (mean from 55% to 73.8%). Mean door to antibiotic time decreased from 87 minutes to 59 minutes. The department compliance to antibiotics from arrival to administration in sixty minutes increased throughout the fiscal year 2024. The department also had one hundred percent compliance for door to antibiotic time within three hours in three months out of the fiscal year. This being the first time the department has achieved one hundred percent compliance with the three-hour metric. The Sepsis Program highlights the value of quality improvement in emergency care, enabling early sepsis detection, timely interventions, and efficient team coordination. Ongoing reviews drive process enhancements and improve patient outcomes.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 145-146"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of and Barriers to Goals of Care Conversations for Patients Admitted to an Acute Oncology Setting","authors":"Breffni Hannon ,&nbsp;Victoria Glinsky ,&nbsp;Neesha Dhani","doi":"10.1016/j.jemermed.2025.04.037","DOIUrl":"10.1016/j.jemermed.2025.04.037","url":null,"abstract":"<div><h3>Background</h3><div>Timely goals of care (GOC) conversations form a crucial component of high-quality cancer care, but are often delayed or do not happen over the course of an inpatient stay. This study aimed to qualitatively explore clinicians’ opinions on the appropriate timing of and barriers to GOC conversations for inpatients admitted to an acute oncology setting.</div></div><div><h3>Methods</h3><div>One-on-one semi-structured interviews were conducted with a purposive sample of interprofessional interdisciplinary team members providing inpatient care at a comprehensive tertiary cancer centre in Toronto, Canada. Interviews were audio-recorded, transcribed and anonymized. Using a thematic analysis approach, interviews were independently reviewed by three researchers to generate initial codes; group coding sessions identified and refined themes and subthemes.</div></div><div><h3>Results</h3><div>Twenty interviews were conducted with clinicians from palliative care (n=3), hospitalist medicine (n=2), medical oncology (n=2), social work (n=4), pharmacy (n=2), physiotherapy/occupational therapy (n=2), intensive care (n=2) and members of the inpatient unit management team (n=3). All participants felt that GOC should be initiated early in the disease trajectory in the outpatient setting by the patient’s primary oncologist, and revisited regularly at transition points in care, as well as specifically prior to or upon acute admission. The increasingly complex landscape of cancer care and access to novel systemic therapy options was identified as a barrier to non-oncologists initiating GOC conversations. While siloed models of care between inpatient and outpatient settings were reported to cause ambiguity around primary responsibility for leading these conversations. Clinician communication skills, appropriate interdisciplinary engagement, and challenging patient or family expectations were additional perceived barriers, while clear and accessible documentation within the electronic medical record was considered suboptimal.</div></div><div><h3>Conclusions</h3><div>Comprehensive GOC conversations are impeded by clinician-, patient- and system-level barriers for patients admitted to acute oncology settings. Targeted strategies aimed at addressing these, tailored to local service models and culture, should be further explored and implemented.</div></div>","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":"76 ","pages":"Pages 142-143"},"PeriodicalIF":1.3,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144858332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}